ImportanceWhile access to psychotherapy has recently increased in the US, concern exists that recent gains may be unevenly distributed despite teletherapy expansion.ObjectiveTo characterize recent trends and patterns in outpatient psychotherapy by US adults.Design, Setting, and ParticipantsThis is a repeated cross-sectional study of psychotherapy use among adults (ages ≥18 years) in the 2018 to 2021 Medical Expenditure Panel Surveys, which are nationally representative surveys of the civilian noninstitutionalized population. Data were analyzed from March to August 2024.Main Outcomes and MeasuresAge-, sex-, and distress-adjusted differences between 2018 and 2021 in use of any psychotherapy and video-based psychotherapy (teletherapy) in 2021 with tests for trend differences (interactions) across levels of sociodemographic characteristics and distress were assessed. Psychological distress was measured using the Kessler-6 scale, with scores of 13 or higher defining serious psychological distress, 1 to 12 defining mild to moderate distress, and 0 defining no distress.ResultsThe analysis involved 89 619 participants (47 838 female [51.5%] and 41 781 male [48.5%]; 22 510 aged 18-34 years [29.0%], 43 371 aged 35-64 years [48.8%], and 23 738 aged ≥65 years [22.2%]). Between 2018 and 2021, psychotherapy use increased significantly faster for females (931/12 270 females [7.7%] to 1207/12 237 females [10.5%]) than males (547/10 741 males [5.2%] to 655/10 544 males [6.3%]), younger (455/6149 individuals [8.0%] to 602/5296 individuals [11.9%] aged 18-34 years) than older (217/5550 individuals [3.6%] to 304/6708 individuals [4.6%] aged ≥65 years) adults, college graduates (503/6456 adults [7.6%] to 810/7277 adults [11.4%]) than those without a high school diploma (193/3824 adults [5.5%] to 200/3593 adults [7.0%]), privately insured (881/14 387 adults [6.1%] to 1154/13 414 adults [8.9%]) than publicly insured (558/6511 adults [8.8%] to 659/7453 adults [8.8%]) individuals, adults at 2 to 4 times the poverty level (370/6670 adults [5.7%] to 488/6370 adults [8.2%]) than those below the poverty level (384/4495 adults [9.7%] to 428/4760 adults [10.0%]), employed persons overall (733/13 358 adults [5.7%] to 1082/12 365 adults [8.9%]) than unemployed persons aged 65 years and younger (547/5138 adults [10.8%] to 519/4905 adults [10.5%]), and urban (1335/20 682 adults [6.5%] to 1729/20 590 adults [8.7%]) than rural (143/2329 adults [6.4%] to 133/2191 adults [5.9%]) residents. In 2021, after controlling for distress level, teletherapy use was significantly higher among younger than middle-aged (aged 35-64 years: difference, −3.7 percentage points; 95% CI, −5.1 to −2.3) or older (aged ≥65 years: difference, −6.5 percentage points (95% CI, −8.0 to −5.0 percentage points) adults, females (difference, 1.9 percentage points; 95% CI, 0.9 to 2.9 percentage points) than males, not married (difference, 2.9 percentage points; 95% CI, 1.6 to 4.2 percentage points) than married persons, college educated adults (difference, 4.9 percentage points; 95% CI, 3.3 to 6.4 percentage points) than those without a high school diploma, people with higher (eg, 400% vs <100% of the federal poverty level: difference, 2.3 percentage points; 95% CI, 1.2 to 3.5 percentage points) than lower incomes, privately than publicly (difference, −2.5 percentage points; 95% CI, −3.4 to −1.5 percentage points) insured persons, and urban (difference, 2.7 percentage points; 95% CI, 1.5 to 3.8 percentage points) than rural residents.ConclusionsThis study found that psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access. These trends and patterns highlight a need for clinical interventions and health care policies to broaden access to psychotherapy including teletherapy.

中文翻译：

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美国成人门诊心理治疗的趋势


重要性虽然美国最近获得心理治疗的机会有所增加，但人们担心尽管远程治疗扩大了，但最近的收益可能分配不均。目的描述美国成年人门诊心理治疗的最新趋势和模式。设计、设置和参与者这是一项对 2018 年至 2021 年医疗支出小组调查中成年人（≥18 岁）心理治疗使用情况的重复横断面研究，该调查是对平民非机构化人口的全国代表性调查。主要结局和措施 2018 年至 2021 年期间使用任何心理治疗和基于视频的心理治疗（远程治疗）的年龄、性别和痛苦调整后的差异，并评估了社会人口学特征和痛苦水平的趋势差异（互动）测试。使用 Kessler-6 量表测量心理困扰，13 分或更高定义为严重心理困扰，1 到 12 分定义为轻度至中度痛苦，0 分定义为无痛苦。结果分析涉及 89 619 名参与者 （47 838 名女性 [51.5%] 和 41 781 名男性 [48.5%];22 510 名 18-34 岁 [29.0%]，43 371 名 35-64 岁 [48.8%] 和 23 738 名 ≥65 岁 [22.2%]）。2018 年至 2021 年期间，女性（931/12 270 名女性 [7.7%] 至 1207/12 237 名女性 [10.5%]）的心理治疗使用增长速度显著快于男性（547/10 741 名男性 [5.2%] 至 655/10 544 名男性 [6.3%]），年轻（455/6149 人 [8.0%] 至 602/5296 人 [11.9%] 年龄在 18-34 岁之间）高于年龄较大的（217/5550 人 [3.6%] 至 304/6708 人 [4.6%] 年龄≥65 岁）成年人、大学毕业生（503/6456 名成年人 [7.6%] 至 810/7277 名成年人 [11.4%]）比没有高中文凭的人（193/3824 名成人 [5.5%] 至 200/3593 名成年人 [7.0%]），私人保险（881/14 387 名成人 [6.1%] 至 1154/13 414 名成年人 [8.9%]）比公共保险（558/6511 名成年人 [8.8%] 至 659/7453 名成人 [8.8%]），处于贫困线以下人群（370/6670 名成人 [5.7%] 至 488/6370 名成人 [8.2%]）的 2 至 4 倍的成年人，低于贫困线的人（384/4495 名成人 [9.7%] 至 428/4760 名成年人 [10.0%]）， 总体就业人数（733/13 358 名成年人 [5.7%] 至 1082/12 365 名成年人 [8.9%]）高于 65 岁及以下的失业者（547/5138 名成年人 [10.8%] 至 519/4905 名成年人 [10.5%]），城市（1335/20 682 名成年人 [6.5%] 至 1729/20 590 名成年人 [8.7%]）比农村（143/2329 名成人 [6.4%] 至 133/2191 名成年人 [5.9%]）居民。2021 年，在控制痛苦水平后，年轻于中年人（35-64 岁：差异，-3.7 个百分点;95% CI，-5.1 至 -2.3）或老年人（年龄≥65 岁：差异，-6.5 个百分点（95% CI，-8.0 至 -5.0 个百分点）的远程治疗使用率显著高于男性、女性（差异，1.9 个百分点;95% CI，0.9 至 2.9 个百分点）。 未婚（差异，2.9个百分点;95% CI，1.6 至 4.2 个百分点）比已婚人士，受过大学教育的成年人（差异，4.9 个百分点;95% CI，3.3 至 6.4 个百分点）比没有高中文凭的人，更高（例如，400% vs <联邦贫困线的 100%：差异，2.3 个百分点;95% CI，1.2 至 3.5 个百分点），低于私人收入的被保险人（差异，-2.5 个百分点;95% CI，-3.4 至 -1.5 个百分点）和城市（差异，2.7 个百分点;95% CI，1.5 至 3.8 个百分点）于农村居民。结论本研究发现，在几个具有社会经济优势的群体中，心理治疗的使用增长明显更快，并且在远程治疗机会方面的不平等很明显。这些趋势和模式凸显了临床干预和医疗保健政策的必要性，以扩大心理治疗（包括远程治疗）的可及性。